Both sides have now laid out strategy roadmaps for the upcoming repeal battle in the Senate. Or not. Right now it feels like a fist-shaking session with a big pissing contest for the finale.
It will go something like this: Senate Democrats will force Republicans to debate and take votes on provisions like closing the doughnut hole, ending exclusions for pre-existing conditions, barring exclusion of children with pre-existing conditions and allowing young adults to remain on their parents' policies until age 26.
Senate Republicans will retaliate by forcing Democrats to vote on the tax-related provisions of the law, including the penalty on the individual mandate, the excise tax on medical device manufacturers, etc.
It will continue what is already a contentious, annoying, academic debate, and one that's not likely to be settled in the Congress, anyway. The downside risk to Democrats will be giving Republicans more time to turn people against it. The downside risk to Republicans is reinforcing the perception they don't really want to 'replace' the law with anything else. Ultimately the Supreme Court will have the final say on the individual mandate. If it is nullified, the entire law could be tossed, since no provision was built in to preserve all other provisions if one provision is found to be unconstitutional.
It's still about the pre-existing conditions. Republicans don't want people with pre-existing conditions to have access to health care unless they can pay for it themselves. Democrats understand that health care is one of the fundamental obligations of a government to its people.
The Affordable Care Act doesn't make the government much larger as a share of GDP. Rather, it commits the government to guaranteeing something close to universal health care, even if the relevant transactions occur between individuals and private insurance companies. The reason the GOP talks about "repeal and replace" is that they don't think they can persuade Americans to undo that underlying commitment. If they did, they'd just go for repeal.
Meanwhile, Vermont marches toward single-payer healthcare for residents there. California passed single payer twice and was twice vetoed. The last time they tried to pass it through the legislature, it failed, but they aren't giving up. It will rise again, particularly in light of Gov. Brown's proposed cuts to Medicaid and MediCal coverage.
I believe the only way to move the country toward a national single payer system is via the states, similar to how Canada's came into being. But before that happens, this nation has to embrace the idea that sick people shouldn't be excluded from access to the health care system, which is what this debate should be about, rather than pissing contests over every damn provision in the Affordable Care Act.
Bonus: Joan McCarter at Daily Kos breaks down a recent poll showing zero support for repeal of the whole thing.
When they actually asked about those certain parts, "8% are opposed to everything and 11% are opposed to the individual mandate. And that's about it. Not a single other provision was opposed by more than 1% of the respondents. Not even higher taxes! Hell, a full 14% were supposedly in favor of repeal but couldn't name even a single provision they disliked."
This makes the piece-by-piece strategy the Senate Dems are devising very smart.
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